Provider Demographics
NPI:1215452867
Name:FUTTERMAN, ROY LOUIS (PHD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:LOUIS
Last Name:FUTTERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CENTRAL PARK W APT 7D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6055
Mailing Address - Country:US
Mailing Address - Phone:917-757-2202
Mailing Address - Fax:
Practice Address - Street 1:75 CENTRAL PARK W APT 7D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6055
Practice Address - Country:US
Practice Address - Phone:917-757-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014426-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical